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In delineating the opportunities and challenges of the Affordable Care Act for physicians, we did not mean to imply that the future health care delivery system will require physicians to be in larger groups or that small practices will lose their role as critical providers of care closely tied to their communities. On the contrary: We believe that many of the opportunities we discussed will provide new ways for small practices to strengthen their intimate ties with patients by linking them to a broader network of technology and infrastructure.

Patients with chronic conditions consume approximately two thirds of health care expenditures and account for nearly 70% of all deaths. Improving the care and reducing the costs of these patients is a major challenge of the health care system. It requires the right blend of information, infrastructure, and incentives. Real-time information about patients' status, such as their weight or hemoglobin A1c, and information about optimal management is essential to high-quality care. Infrastructure and incentives help ensure that keeping patients healthy and out of the hospital is financially viable for office practices.